Provider Demographics
NPI:1194888693
Name:COBB, ARTHUR L (PHD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:L
Last Name:COBB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 PARK AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8919
Mailing Address - Country:US
Mailing Address - Phone:617-868-0853
Mailing Address - Fax:
Practice Address - Street 1:271 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3580
Practice Address - Country:US
Practice Address - Phone:617-868-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA663103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA169751OtherMAGELLAN HEALTH SERVICES
MAW01497Medicare ID - Type Unspecified